77011 Computed tomography guidance for stereotactic localization – Average Fee amount $220- 240

77012 Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation – Average Fee amount $100 -$140

77013 Computerized tomography guidance for, and monitoring of, parenchymal tissue ablation  Average Fee amount

77014 Computed tomography guidance for placement of radiation therapy fields -Average Fee amount

Image Guided Radiation Therapy (IGRT) Codes (HCPCS codes G6001, 77014, G6002)

IGRT is a form of adaptive radiation therapy, which utilizes imaging technology to guide action(s) that modifies the treatment in reference to the intended target, In IGRT, the external beam radiation treatment setup is accomplished with direct visualization of the target volume, implanted fiducial markers or adjacent anatomical structures. These guidance images are compared to the designated target(s) as delineated on the treatment isodose plan. An adjustment may then be required to achieve an accurate concordance of dose distribution with the original plan. IGRT is used in patients whose tumors are directly adjacent to critical structures and where conventional means of targeting are deemed to be inadequate. IGRT must be performed by the radiation oncologist, medical  physicist or trained radiation therapist under the supervision of the radiation oncologist. The physician must supervise and review the procedure, as the guidance may show a shift beyond standard tolerances.

The current supervision requirements for the technical component of the IGRT procedure codes are as follows: HCPCS code G6001 requires general supervision, CPT code 77014 requires direct supervision and HCPCS code G6002 requires direct supervision. General supervision means the procedure is furnished under the physician’s overall direction and control, but the physician’s presence is not required during the performance of the procedure.

Direct supervision in the office setting means the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure.

It does not mean that the physician must be present in the room when the procedure is performed.

Personal supervision means a physician must be in attendance in the room during the performance of the procedure.

Indications and Limitations of Coverage and/or Medical Necessity

There are numerous indications for the use of Computed Tomography (CT). This policy makes general statements regarding the preferred indications for CT. Refer to the specific codes for covered indications. Medicare Coverage Issues Manual, 50-12. Diagnostic examination of the head and of other part of the body is covered if medical literature supports the use of said diagnostic procedure for the specific condition. The scan should be reasonable and necessary for the individual patient, and performed on a model of CT equipment that meets specific criteria

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

0340 – 0349
0350 – 0359
0400 – 0409
0610 – 0619

Procedure code®77011: A stereotactic CT localization scan is frequently obtained  prior to sinus surgery. The dataset is then loaded into the navigational workstation in the operating room for use during the surgical procedure.

The information provides exact positioning of surgical instruments with regard to the patient’s 3D CT images.

** In most cases, the preoperative CT is a technical-only service that does not require interpretation by a radiologist.

** The imaging facility should report Procedure code ®77011 when performing a scan not requiring interpretation by a radiologist.

** If a diagnostic scan is performed and interpreted by a radiologist, the appropriate diagnostic CT code (e.g., Procedure code ®70486) should be used.

** It is not appropriate to report both Procedure code ®70486 and Procedure code ®77011 for the same CT stereotactic localization imaging session.

** 3D Rendering (Procedure code ®76376 or Procedure code ®76377) should not be reported in conjunction with Procedure code ®77011 (or Procedure code ®70486 if used). The procedure inherently generates a 3D dataset.

Procedure code ®77012 (CT) and Procedure code ®77021 (MR) are used to report imaging guidance for needle placement during biopsy, aspiration, and other percutaneous procedures.

** These codes represent the radiological supervision and interpretation of the procedure and are often billed in conjunction with surgical procedure codes.

** For example, Procedure code ®77012 is reported when CT guidance is used to place the needle for a conventional arthrogram.

** Only codes representing percutaneous surgical procedures should be billed with Procedure code ®77012 and Procedure code ®77021. It is inappropriate to use with surgical codes for open, excisional, or incisional procedures.

Procedure code ®77013 (CT) and Procedure code®77022 (MR) include the initial guidance to direct a needle electrode to the tumor(s), monitoring for needle electrode repositioning within the lesion, and as necessary for multiple ablations to coagulate the lesion and confirmation of satisfactory coagulative necrosis of the lesion(s) and comparison to pre-ablation images.

** NOTE: Procedure code ®77013 should only be used for non-bone ablation procedures.

** Procedure code ®20982 includes CT guidance for bone tumor ablations.

** Only codes representing percutaneous surgical procedures should be billed with Procedure code®77013 and Procedure code ®77022. It is inappropriate to use with surgical codes for open, excisional, or incisional procedures.

Computed tomography guidance for placement of radiation therapy fields (77014)

Providers may not report CT guidance (77014) separately when reporting simulation services represented by codes 77280-77290 as CT guidance is now packaged into the simulation codes for both hospitals and freestanding centers. The same rule also applies to 3D conformal planning code 77295. In 2015 and 2016, code 77014 is still the correct CPT code to report image guidance with kV or MV CT imaging in the Medicare Physician Fee Schedule (MPFS) setting

Continuing Medical Physics Code 77336

Weekly physics, code 77336, is reported with external beam radiation therapy or brachytherapy once per 5-fraction period, regardless of the actual time period in which services are provided. If the course combines EBRT and brachytherapy, each encounter will count as a fraction for the 5-fraction period, regardless of the duration between those fractions or the modality. Code 77336 is not reported when there is only a single fraction in the brachytherapy course, such as a prostate seed implant

Billing and Coding Guidelines

 Billing Instructions for IMRT Planning

Payment for the services identified by Procedure codes 77014, 77280 through 77295, 77305 through 77321, 77331, and 77370 is included in the APC payment for Procedure code 77301 (Intensity Modulated Radiation Therapy (IMRT) planning). These codes should not be reported in addition to Procedure code 77301 (on either the same or a different date of service) unless these services are being performed in support of a separate and distinct non-IMRT radiation therapy for a different tumor.

(Do not report code 0340T in conjunction with 76940, 77013, 77022)

77014 Computed tomography guidance for placement of radiation fields (*this code replaces 76370)

Services incidental to intensity-modulated radiation therapy (IMRT)

Services identified by CPT codes 77014, 77280 through 77295, 77305 through 77321, 77331 and 77370 are included in the payment for CPT code 77301 (IMRT planning). These services are incidental to IMRT and should not be reported in addition to CPT code 77301 — on either the same or different date of service.

Bundled Services -professional

Based on coding changes effective January 1, 2014, providers should no longer separately report CT guidance, represented by Procedure code ® code 77014 (Computed tomography guidance for placement of radiation therapy fields), when reporting simulation services represented by codes 77280-77290. The use of CT guidance is considered integral to the simulation; therefore, for claims processed on or after November 16, 2015, Procedure code 77014 will no longer be eligible for separate reimbursement when reported with Procedure codes 77280-77290. This information is included in our Modifiers 59, XE, XP, XS, and XU policy since modifiers will not override this edit.

Advanced Radiology including PET scans, CT Scans, MRI’s require authorization inclusive of the following codes:

– All of the following radiology/imaging codes are effective February 1, 2016: 70460, 70470, 70481, 70482, 70486-70492, 70496, 70498, 70540, 70551-70553, 71250, 71260, 71270, 71275, 71550-71552, 72126, 72127, 72129, 72130, 72132, 72133, 72156-72158, 72192-72194, 72291, 72292, 73200-73202, 73218-73223, 73225, 73700-73702, 74150, 74160, 74170, 74174-74176, 74178, 74179, 75557, 75559, 75561, 75563, 75565, 76120, 76125, 77011-77013, 77021, 77022, 77084, 78226, 78227, 78350, 78351, 78445, 78451-78454, 78466, 78468, 78469, 78472, 78473, 78481, 78483, 78494, 78496, 78579, 78580, 78582, 78805-78